The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.

This report examines the impact of individualized, population-based recruitment and retention approaches on the development of a subject pool, enrollment, and retention at 12 months of healthy, community-based women in three ethnic groups: African Americans, non-Hispanic European Americans, and Mexicans/Central Americans. Of 722 women contacted and screened, 346 (48%) were eligible and consented to participate. Attrition at 12 months was low (10%) compared with other published reports. The largest group of potential subjects was identified through broadcast media approaches, but this method produced the highest number of ineligible women and highest rate of attrition. Printed matter produced the next largest group of potential subjects, but ineligibility was high (53%). Face-to-face interactions enrolled the highest proportion of eligible women (84%) and lowest overall attrition (7%). Direct referral yielded fairly efficient enrollments (57%) and average attrition. Multiple approaches for recruitment can produce a diverse sample of healthy, community-based women. Face-to-face recruitment results in the highest yield of participants with the lowest attribution but is presumed to require more resources.

OBJECTIVE: To conduct a retrospective observational cohort study to estimate the abortion complication rate, including those diagnosed or treated at emergency departments (EDs). METHODS:Using 2009-2010 abortion data among women covered by the fee-for-service California Medicaid program and all subsequent health care for 6 weeks after having an abortion, we analyzed reasons for ED visits and estimated the abortion-related complication rate and the adjusted relative risk. Complications were defined as receiving an abortion-related diagnosis or treatment at any source of care within 6 weeks after an abortion. Major complications were defined as requiring hospital admission, surgery, or blood transfusion. RESULTS:A total of 54,911 abortions among 50,273 feefor-service Medi-Cal beneficiaries were identified. Among all abortions, 1 of 16 (6.4%, n53,531) was followed by an ED visit within 6 weeks but only 1 of 115 (0.87%, n5478) resulted in an ED visit for an abortionrelated complication. Approximately 1 of 5,491 (0.03%, n515) involved ambulance transfers to EDs on the day of the abortion. The major complication rate was 0.23% (n5126, 1/436): 0.31% (n535) for medication abortion, 0.16% (n557) for first-trimester aspiration abortion, and 0.41% (n534) for second-trimester or later procedures. The total abortion-related complication rate including all sources of care including EDs and the original abortion facility was 2.1% (n51,156): 5.2% (n5588) for medication abortion, 1.3% (n5438) for first-trimester aspiration abortion, and 1.5% (n5130) for second-trimester or later procedures.CONCLUSION: Abortion complication rates are comparable to previously published rates even when ED visits are included and there is no loss to follow-up. 1 accurate estimates of abortion complications are paramount to assess and improve quality of care and determine how public policies can most effectively safeguard women's health. Although national abortion-related mortality data exist for the United States, 2 no surveillance system captures abortion-related morbidity. Studies find varying complication rates 3-7 depending on the procedure, weeks of gestation, length of follow-up, and protocols used to detect complications. Furthermore, complication rates are underestimated by low followup rates. 5,[7][8][9] Published complication rates are considered incomplete because they usually do not include those diagnosed at sites other than the original source of care. 10From the Advancing New Standards in Reproductive Health